JAN JOURNAL OF ADVANCED NURSING

ORIGINAL RESEARCH

Tablet-splitting: a common yet not so innocent practice

Charlotte Verrue, Els Mehuys, Koen Boussery, Jean-Paul Remon & Mirko Petrovic

Accepted for publication 6 August 2010

Correspondence to C. Verrue:
e-mail: charlotte.verrue@ugent.be
Charlotte Verrue PharmD PhD
Post-doctoral Researcher
Pharmaceutical Care Unit, Faculty of
Pharmaceutical Sciences, Ghent University,
Belgium
Els Mehuys PharmD PhD
Post-doctoral Researcher
Pharmaceutical Care Unit, Faculty of
Pharmaceutical Sciences, Ghent University,
Belgium
Koen Boussery PharmD PhD
Post-doctoral Researcher
Pharmaceutical Care Unit, Faculty of
Pharmaceutical Sciences, Ghent University,
Belgium
Jean-Paul Remon PharmD PhD
Professor of Pharmaceutical Technology
Pharmaceutical Care Unit, Faculty of
Pharmaceutical Sciences, Ghent University,
Belgium
Mirko Petrovic MD PhD
Professor of Geriatrics
Department of Geriatrics, Ghent University
Hospital, Belgium
VERRUE C., MEHUYS E., BOUSSERY K., REMON J.-P. & PETROVIC M.
( 2 0 1 1 ) Tablet-splitting: a common yet not so innocent practice. Journal of Advanced
Nursing 67(1), 26–32. doi: 10.1111/j.1365-2648.2010.05477.x
Abstract
Aim. This paper is a report of a study conducted to quantify (i) the mean deviation
from theoretical weight and (ii) the mean weight loss, after tablet-splitting with
three different, commonly used splitting methods.
Background. Tablet-splitting is a widespread practice among all sectors of health
care for different reasons: it increases dose flexibility, makes tablet parts easier to
swallow and allows cost savings for both patients and healthcare providers. How-
ever, the tablet parts obtained are often not equal in size, and a substantial amount
of tablet can be lost during splitting.
Method. Five volunteers were asked to mimic the situation in nursing homes and to
split eight tablets of different sizes and shapes using three different routine methods:
(i) with a splitting device (Pilomat), (ii) with scissors for unscored tablets or manual
splitting for scored tablets and (iii) with a kitchen knife. Before and after splitting,
tablets and tablet parts were weighed using an analytical balance. The data were
collected in 2007.
Results. For all tablets, method 1 gave a statistically significantly lower mean
deviation from theoretical weight. The difference between method 2 and method 3
was not statistically significant. When pooling the different products, method 1 also
induced significantly less weight loss than the two other methods.
Conclusion. Large dose deviations or weight losses can occur while splitting tablets.
This could have serious clinical consequences for medications with a narrow ther-
apeutic-toxic range. On the basis of the results in this report, we recommend use of a
splitting device when splitting cannot be avoided.

Keywords: nursing, nursing homes, practice guideline, tablet-splitting, weight

deviations

splitting tablets improves dose flexibility, which is important

Introduction
Tablet-splitting is a widespread practice internationally in all
sectors of health care. A study in primary care in Germany
showed that 24Æ1% of all drugs were split (Quinzler et al.
2006). There are multiple reasons for this practice. First,
when doses need to be adapted to the specific needs of
certain patient populations (e.g. older adults, children) or
when doses need to be thoroughly titrated (Fischbach et al.
2001). Second, it makes the different tablet parts easier to
swallow. Finally, it could allow cost savings for both

26  2010 Blackwell Publishing Ltd

JAN: ORIGINAL RESEARCH Tablet-splitting

patients and healthcare providers, because the use of flat rate
charges for medications, independent of dose strength, is
common (Biron et al. 1999, Van Santen et al. 2002, Polli
et al. 2003).
In nursing homes, nurses are responsible for the adminis-
tration of medication to residents, and consequently for
splitting tablets. Medication errors, especially during the
administration to residents, are an important concern in
nursing homes (Handler et al. 2004, Hansen et al. 2006,
Pierson et al. 2007). The most frequently reported types of
errors are omissions, wrong doses, wrong techniques and
unauthorised drug administration (Barker et al. 1982, 2002,
Pierson et al. 2007, Gerber et al. 2008, Barber et al. 2009,
Van Den Bemt et al. 2009). Inaccurate splitting constitutes
both a wrong technique when it is performed without the
correct device and a dosing error, and could potentially result
in harm for residents. Our observations in nursing homes
have shown that nurses split 15% of the medications they
prepare (own unpublished observations, 2006). To this
end, various methods are used: (i) a splitting device (e.g.
Pilomat), (ii) splitting by hand (for scored tablets) or with
scissors (for unscored tablets), or (iii) with a kitchen knife.
There has been previous research on the impact of tablet-
splitting on dose accuracy. Reports published so far have
concerned splitting devices (Peek et al. 2002, Cook et al.
2003, Boggie et al. 2004), kitchen knives (Cook et al. 2003)
and splitting by hand (Babington 1997, Boggie et al. 2004).
However, no researchers have compared the weight unifor-
Table 1 Characteristics of the volunteers
Age Splitting
Volunteer Gender (years) Training level experience?
1 M 55 Laboratory technician Yes
2 F 37 Administrative coworker No
3 M 37 Pharmacist, professor No
4 F 21 Pharmacy student No
5 F 24 Pharmacist, researcher No
mity of all splitting methods used in nursing homes. Such
data are necessary to provide nursing homes with advice on
the best possible splitting technique.
The study
Aim
The aim of the study was to quantify (i) the mean deviation
from theoretical weight and (ii) the mean weight loss, after
tablet-splitting with three different, commonly used splitting
methods.
Design
An experimental design was adopted and the data were
collected in 2007.
Participants
Five volunteers (two men and three women aged 21–
55 years) were recruited among the co-workers at the faculty
to perform the splitting. Details are displayed in Table 1.
Data collection
Eight commercially available tablets of different sizes and
shapes, and which are commonly split in nursing homes, were
selected for the experiment. Table 2 gives an overview of the
characteristics of these tablets. Marcoumar and Marevan
were selected because of the therapeutic schemes that are
meticulously titrated and they require frequent splitting.
Medrol and Zestril were selected because they are mainly
split for economic reasons. The four remaining tablets were
included because experienced nurses indicated that the tablets
often cause problems during splitting (Lanoxin is a very small
tablet of 5Æ6 mm, Merck-Metformine is a big round tablet
without scoring lines, Aldactone is a coated tablet, and

Table 2 Tablet characteristics

Number of Split
Product Active ingredient score lines Shape Flat? into

Marevan Warfarin 1 Round Yes 2

Lanoxin Digoxin 0 Round Yes 2
Merck-Metformine Metformin 0 Round No 2
Sinemet Levodopa + carbidopa 1 Oblong No 2
Marcoumar Fenprocoumon 2 Round Yes 4
Aldactone Spironolactone 0 Round No 4
Medrol Methylprednisolone 2 Oblong No 4
Zestril Lisinopril 1 Round No 4

 2010 Blackwell Publishing Ltd 27

C. Verrue et al.

splitting Sinemet causes important losses). Nevertheless, these
tablets are often prescribed in halves or quarters. Four
formulations were designated to be split in halves, four others
had to be split in quarters, according to previous observations
in nursing homes (own unpublished observations, 2006). Three
different routine splitting methods were assessed: (i) a splitting
device (Pilomat, which is the most frequently used commer-
cially available device in Belgium), (ii) scissors for unscored
tablets or hand-splitting of scored tablets and (iii) a kitchen
knife. No specific splitting guidelines or instructions were
given. Per volunteer and per method, the initial weight of ten
tablets of each formulation was assessed using an electronic
analytical balance (Mettler Toledo AG 245), and the mass of
each tablet was recorded with an accuracy of 0Æ1 mg. After
splitting, each half or quarter (depending on the formulation)
was individually weighed. For each tablet part, the deviation
from the theoretical weight and the weight loss were calculated
as follows: theoretical weight = weight of the tablet before
splitting/2 or 4 (depending on the tablet); deviation (%) from
theoretical weight = (weight of the tablet fragment theoret-
ical weight)/theoretical weight · 100; weight loss = weight of
the tablet before splitting sum of all (2 or 4) tablet fragments.
Ethical considerations
The study did not require approval from an ethics committee
since we did not collect patient data.
Data analysis
Percent variation and percent weight loss among the three
splitting methods were compared with a one-way ANOVA test
and Tukey’s post hoc test, using SPSS version 17.0 for
Windows (SPSS, Inc., Chicago, IL, USA).
Results
Table 3 displays the mean deviation from the theoretical
weight for the different tablet parts of each product and the
comparison between the three different methods, using a one-
way ANOVA test and Tukey’s post hoc test. Overall results
(grouping the different formulations) are also given. Overall,
method 1 provides a significantly lower mean deviation from
theoretical weight. The difference between method 2 and
method 3 is not statistically significant.
Table 4 displays the number of tablet parts that deviate
between 15% and 25% from theoretical weight, and the
number of tablet parts that deviate more than 25% from the
theoretical weight. While using the third splitting method,
that is, splitting with a kitchen knife, some tablet fragments
fell on to the floor. These fragments were no longer included
in the data processing. As the results show, method 1
produced the smallest number of tablet parts deviating
between 15% and 25% from theoretical weight and deviat-
ing more than 25% from theoretical weight.
Not only weight deviations from theoretical weight, but
also weight losses were recorded. These results are summa-
rized in Table 5. Method 1 gave the lowest weight loss of
all three methods only for Lanoxin. For Marevan,
Sinemet, Marcoumar, Medrol and Zestril; the differ-
ence between methods 1 and 2 was not statistically
significant: both gave a smaller weight loss compared to
method 3. For one tablet (Merck-Metformine), there was
no significant difference between the three methods. For the

Table 3 Mean and maximum deviation from theoretical weight (%) for the three evaluated methods (N = 50)
Method 1 Method 2 Method 3
P value* P value* P value*
Drug Mean SD Max Mean SD Max Mean SD Max Method 1 vs. 2 Method 1 vs. 3 Method 2 vs. 3

Marevan 5Æ55 6Æ32 26Æ47 12Æ43 10Æ61 34Æ82 6Æ89 5Æ45 27Æ83 <0Æ001 0Æ677 0Æ002
Lanoxin 6Æ64 6Æ06 24Æ02 18Æ94 13Æ01 51Æ07 17Æ52 14Æ38 68Æ01 <0Æ001 <0Æ001 0Æ819
Merck-Metformine 10Æ43 10Æ14 50Æ04 17Æ50 10Æ06 43Æ55 14Æ58 9Æ35 34Æ09 0Æ001 0Æ093 0Æ302
Sinemet 5Æ65 4Æ74 23Æ28 5Æ75 4Æ77 21Æ49 8Æ30 14Æ34 53Æ18 0Æ999 0Æ321 0Æ347
Marcoumar 11Æ08 9Æ86 55Æ11 11Æ44 9Æ77 35Æ29 12Æ54 11Æ53 53Æ17 0Æ984 0Æ767 0Æ859
Aldactone 11Æ43 10Æ06 38Æ38 18Æ79 13Æ64 57Æ73 20Æ45 14Æ03 57Æ36 0Æ012 0Æ002 0Æ792
Medrol 11Æ75 9Æ85 46Æ44 22Æ27 20Æ26 85Æ98 12Æ87 10Æ09 41Æ02 0Æ001 0Æ919 0Æ003
Zestril 13Æ77 12Æ79 58Æ48 14Æ58 12Æ51 48Æ00 16Æ02 12Æ99 53Æ83 0Æ947 0Æ655 0Æ840
Overall 9Æ54 9Æ48 58Æ48 15Æ21 13Æ35 85Æ98 13Æ68 12Æ54 68Æ01 <0Æ001 <0Æ001 0Æ163

Method 1: with a splitting device; Method 2: with scissors or by hand; Method 3: with a kitchen knife.
*one-way ANOVA , post hoc: Tukey test.

N = 48.
Statistically significant values are given in bold.

28  2010 Blackwell Publishing Ltd

JAN: ORIGINAL RESEARCH Tablet-splitting

Table 4 Number of tablet fragments deviating more than 15% and more than 25% from the theoretical weight
Method 1 Method 2 Method 3

Deviation Deviation Deviation Deviation Deviation Deviation

Drug 15–25% >25% 15–25% >25% 15–25% >25%

Marevan 6/100 2/100 16/100 19/100 4/96* 1/96*

Lanoxin 9/100 0/100 24/100 30/100 23/100 19/100
Merck-Metformine 10/100 10/100 29/100 16/100 24/99* 16/99*
Sinemet 2/100 0/100 5/100 0/100 2/100 2/100
Marcoumar 40/200 20/200 66/200 23/200 28/200 23/200
Aldactone 41/200 17/200 33/200 38/200 34/200 66/200
Medrol 28/200 17/200 44/200 57/200 45/195* 24/195*
Zestril 23/200 29/200 43/200 43/200 41/196* 47/196*
Overall 159/1200 95/1200 260/1200 226/1200 201/1186 198/1186

Method 1: with a splitting device; Method 2: with scissors or by hand; Method 3: with a kitchen knife.
*Tablet fragments that fell on the floor during splitting were no longer included.

Table 5 Weight-loss after tablet-splitting (%), with comparison between the three methods evaluated (N = 50)
Method 1 Method 2 Method 3
P value* P value* P value*
Drug Mean SD Max Mean SD Max Mean SD Max Method 1 vs. 2 Method 1 vs. 3 Method 2 vs. 3

Marevan 0Æ93 0Æ92 4Æ07 0Æ72 2Æ27 15Æ85 2Æ17 3Æ41 17Æ72 0Æ897 0Æ031 0Æ009
Lanoxin 1Æ44 2Æ06 8Æ19 7Æ55 8Æ43 36Æ95 5Æ37 8Æ00 37Æ61 <0Æ001 0Æ012 0Æ249
Merck-Metformine 1Æ75 5Æ08 26Æ60 1Æ71 2Æ35 11Æ65 1Æ41 2Æ47 11Æ24 0Æ998 0Æ884 0Æ907
Sinemet 0Æ46 0Æ44 2Æ51 0Æ10 0Æ32 1Æ55 2Æ25 4Æ74 27Æ40 0Æ799 0Æ004 <0Æ001
Marcoumar 2Æ03 2Æ54 9Æ87 0Æ56 1Æ14 6Æ53 4Æ52 4Æ65 15Æ93 0Æ053 <0Æ001 <0Æ001
Aldactone 2Æ28 1Æ86 10Æ16 4Æ80 3Æ34 16Æ11 3Æ40 2Æ76 11Æ91 <0Æ001 0Æ103 0Æ030
Medrol 0Æ47 1Æ72 6Æ57 0Æ95 2Æ01 9Æ61 3Æ63 3Æ47 13Æ92 0Æ601 <0Æ001 <0Æ001
Zestril 0Æ76 1Æ54 6Æ33 1Æ49 0Æ97 5Æ11 4Æ07 2Æ98 11Æ87 0Æ165 <0Æ001 <0Æ001
Overall 1Æ56 2Æ48 26Æ60 2Æ36 4Æ30 36Æ95 3Æ42 4Æ55 37Æ61 0Æ016 <0Æ001 <0Æ001

Method 1: with a splitting device; Method 2: with scissors or by hand; Method 3: with a kitchen knife.
*One-way ANOVA , post hoc: Tukey test.
Statistically significant values are given in bold.

remaining tablet (Aldactone), there was no statistically
significant difference between methods 1 and 3, both giving
a smaller weight loss than method 2. However, when
pooling the results for the different tablets, method 1
induced statistically significantly less weight loss than the
other two methods.
Discussion
Study limitations
This study had some limitations. It could be argued that we
did not compare three distinct methods, since method 2
consisted of splitting by hand whenever the tablet had a score
line or with scissors when the tablet was unscored. However,
we wanted to compare three routine methods in order to
identify the best possible splitting guidelines for daily
practice. Another criticism might be that no nurses were
included in the volunteer group. However, splitting is
not always performed by professional nurses. Therefore,
we chose to include an administrative coworker with no
scientific background or splitting experience, a laboratory
technician used to splitting his own medication, a pharmacy
student who was still in training, and two pharmacists. We
believe that this group was heterogeneous enough to simulate
the nursing home environment. If there was any bias, it might
have been a positive one, meaning that our volunteers might
have split the tablets more accurately than would have been
done in daily nursing home practice. Moreover, we did not
investigate the clinical effect of the weight deviations. It
seems logical that clinical consequences are small in long-
term therapies with agents with long half-lives or high
therapeutic indexes. This has been shown for lisinopril in
hypertension therapy and HMG-CoA reductase inhibitors

 2010 Blackwell Publishing Ltd 29

C. Verrue et al.
What is already known about this topic
• Tablet-splitting is common practice in all sectors of
health care.
• Literature has shown that large dose deviations and
weight losses can occur during splitting.
• Extrapolation of the results from previous studies to
daily practice is difficult.
What this paper adds
• Use of a splitting device gives a significant lower mean
deviation from theoretical weight than the two other
methods.
• Use of a splitting device induces significantly less weight
loss than splitting by hand (for scored tablets) or with
scissors (for unscored tablets), than splitting with a
kitchen knife.
Implications for practice and/or policy
• The use of a splitting device is recommended as routine
method when splitting cannot be avoided.
• Pharmacists should give clear messages about the risks
related to splitting.
• Manufacturers could avoid the need for splitting by
introducing a wider range of tablet doses or liquid
formulations.
(simvastatin, atorvastatin and lovastatin) in the treatment of
hypercholesterolemia and hyperlipidemia (Duncan et al.
2002, Gee et al. 2002). However, there might be some
serious clinical consequences when a splitting method is used
that produces important dose deviations, for acute therapies,
or for drugs with short half-lives or low therapeutic indexes.
We believe, however, that these limitations do not undermine
the reliability of our advice to nursing homes.
Effects of tablet-splitting
Splitting tablets leads to high variability in both fragment
weights and weight losses. This study was undertaken to
evaluate the best method for daily tablet-splitting in nursing
homes. Although some literature is available on this topic,
authors have reported their findings in different ways, making
comparison difficult. Some have reported deviation ranges
(Cook et al. 2003), while others have reported the percentage
of tablet fragments deviating more than 10% or 20% from
theoretical weight (Mcdevitt et al. 1998), mean deviations
30
(Boggie et al. 2004) or maximum losses (Biron et al. 1999).
Some studies focused on only one splitting method or type of
drug (Mcdevitt et al. 1998, Biron et al. 1999), while others
compared different methods (Peek et al. 2002, Teng et al.
2002, Cook et al. 2003) or different tablets (Polli et al. 2003,
Boggie et al. 2004, Kayumba et al. 2006). The majority of
this literature is a few years old now, whereas the practice
remains very alive and still problematic. Moreover, as stated
before, we did not find any study that used our second
method, that is, splitting by hand for scored tablets or with
scissors for unscored tablets. The relevance of these diverse
literature data to daily nursing practice is therefore not
obvious, whereas the research question at the basis of our
experiment was actually quite simple. We aimed at providing
nursing homes with advice for the best splitting technique
in daily practice. This means that we needed to search for a
technique that is applicable and reliable regardless of the
dexterity or training level of the person performing the
splitting, and regardless of the tablet’s characteristics. Indeed,
in nursing home settings, splitting can be performed by
experienced or newly graduated nurses, by pharmacists or
sometimes even by nursing aides, all with different splitting
skills. Therefore, we chose a heterogeneous sample of
volunteers for our experiment. Moreover, only one method
should be advised for all kinds of tablets in daily practice.
Using different methods for different types of formulations
would be confusing and would induce errors. Therefore, we
selected tablets with different characteristics (including a
generic brand: Merck-Metformine) to be included in the
study. In this way, the findings can be generalized, regardless
of the tablet or its brand. This is important, given the move to
use generic rather than proprietary brands. Five volunteers,
each splitting ten tablets of each type with the three different
methods (in total, 1200 tablets were split), formed a
reasonable sample size.
The results showed a high variability in weight deviation
and weight loss between the different methods. The use of a
splitting device appeared to be the best method for splitting
tablets, since it yielded smaller weight deviations and smaller
weight losses than using scissors for unscored tablets (and
hand splitting for scored tablets) or using a kitchen knife.
Conclusion
Tablet-splitting is daily practice in nursing homes. However,
not all formulations are suitable for splitting, and even when
they are, large dose deviations or weight losses can occur.
This could have serious clinical consequences for medications
with a narrow therapeutic-toxic range. On the basis of our
results, we recommend use of a splitting device when splitting
 2010 Blackwell Publishing Ltd
JAN: ORIGINAL RESEARCH
cannot be avoided (i.e. for example when the prescribed dose
is not commercially available, or when there is no alternative
formulation, such as a liquid). Nursing home staff performing
the splitting should also be educated in splitting as accurately
as possible, and should be aware of the possible clinical
consequences of dose deviations. As for policy implications,
we recommend that manufacturers make it possible to avoid
splitting, by introducing a wider range of tablet doses or
liquid formulations.
Acknowledgements
We would like to thank the volunteers for their valuable help
during this study.
Funding
This research received no specific grant from any funding
agency in the public, commercial, or not-for-profit sectors.
Conflict of interest
No conflict of interest has been declared by the authors.
Author contributions
CV, EM and JPR were responsible for the study conception
and design. CV performed the data collection. CV and EM
performed the data analysis. CV, EM, KB, JPR and MP
were responsible for the drafting of the manuscript. CV,
EM, KB, JPR and MP made critical revisions to the paper
for important intellectual content. CV, EM and KB
provided statistical expertise. JPR provided administrative,
technical or material support. KB, JPR and MP supervised
the study.
References
Babington M.A. (1997) Use of a geriatric formulary in long-term
care. Medical Interface 10(1), 87–89.
Barber N.D., Alldred D.P., Raynor D.K., Dickinson R., Garfield S.,
Jesson B., Lim R., Savage I., Standage C., Buckle P., Carpenter J.,
Franklin B.D., Woloshynowych M. & Zermansky A.G. (2009)
Care homes’ use of medicines study: prevalence, causes and
potential harm of medication errors in care homes for older people.
Quality & Safety in Health Care 18, 341–346.
Barker K.N., Mikeal R.L., Pearson R.E., Illig N.A. & Morse M.L.
(1982) Medication errors in nursing-homes and small hospitals.
American Journal of Hospital Pharmacy 39, 987–991.
Barker K.N., Flynn E.A., Pepper G.A., Bates D.W. & Mikeal R.L.
(2002) Medication errors observed in 36 health care facilities.
Archives of Internal Medicine 162, 1897–1903.
 2010 Blackwell Publishing Ltd
Tablet-splitting
Biron C., Licznar P., Hansel S. & Schved J.F. (1999) Oral antico-
agulant drugs: do not cut tablets in quarters. Thrombosis and
Haemostasis 82, 1201.
Boggie D.T., Delattre M.L., Schaefer M.G., Morreale A.P. &
Plowman B.K. (2004) Accuracy of splitting unscored valdecoxib
tablets. American Journal of Health-System Pharmacy 61, 1482–
1483.
Cook T.J., Edwards S., Gyemah C., Shah M., Shah I. & Fox T.
(2003) Variability in tablet fragment weights when splitting un-
scored cyclobenzaprine 10 mg tablets. Journal of the American
Pharmacy Association 44, 583–586.
Duncan M.C., Castle S.S. & Streetman D.S. (2002) Effect of tablet
splitting on serum cholesterol concentrations. Annals of Pharma-
cotherapy 36, 205–209.
Fischbach M.S., Gold J.L., Lee M., Dergal J.M., Litner G.M. &
Rochon P.A. (2001) Pill-splitting in a long-term care facility.
Canadian Medical Association Journal 164, 785–786.
Gee M., Hasson N., Hahn T. & Ryono R. (2002) Effects of a
tablet-splitting program in patients taking HMG-CoA reductase
inhibitors: analysis of clinical effects, patient satisfaction, com-
pliance, and cost avoidance. Journal of Managed Care Pharmacy
8, 453–458.
Gerber A., Kohaupt I., Lauterbach K.W., Buescher G., Stock S. &
Lungen M. (2008) Quantification and classification of errors
associated with hand-repackaging of medications in long-term care
facilities in Germany. The American Journal of Geriatric Phar-
macotherapy 6, 212–219.
Handler S.M., Nace D.A., Studenski S.A. & Fridsma D.B. (2004)
Medication error reporting in long-term care. The American
Journal of Geriatric Pharmacotherapy 2, 190–196.
Hansen R.A., Greene S.B., Williams C.E., Blalock S.J., Crook
K.D., Akers R. & Carey T.S. (2006) Types of medication errors
in North Carolina nursing homes: a target for quality improve-
ment. The American Journal of Geriatric Pharmacotherapy 4,
52–91.
Kayumba P.C., Huyghebaert N., Ntawukuliryayo J.D., Vervaet C. &
Remon J.P. (2006) Impact du cassage de comprimés de sulfate de
quinine sur l’exactitude de la dose administrée aux enfants.
Le pharmacien d’Afrique 193, 11–16.
Mcdevitt J.T., Gurst A.H. & Chen Y.S. (1998) Accuracy of tablet
splitting. Pharmacotherapy 18, 193–197.
Peek B.T., Al-Achi A. & Coombs S.J. (2002) Accuracy of tablet
splitting by elderly patients. Journal of the American Medical
Association 288, 451–452.
Pierson S., Hansen R., Greene S., Williams C., Akers R., Jonsson M.
& Carey T. (2007) Preventing medication errors in long-term care:
results and evaluation of a large scale web-based error reporting
system. Quality & Safety in Health Care 16, 297–302.
Polli J.E., Kim S. & Martin B.R. (2003) Weight uniformity of split
tablets required by a Veterans Affairs policy. Journal of Managed
Care Pharmacy 9, 401–407.
Quinzler R., Gasse C., Schneider A., Kaufmann-Kolle P., Szecsenyi J.
& Haefeli W.E. (2006) The frequency of inappropriate tablet
splitting in primary care. European Journal of Clinical Pharma-
cology 62, 1065–1073.
Teng J., Song C., Williams R. & Polli J. (2002) Lack of medication
dose uniformity in commonly split tablets. Journal of the American
Pharmaceutical Association 42, 195–199.
31
C. Verrue et al.

Van Den Bemt P.M.L.A., Idzinga J.C., Robertz H., Kormelink D.G.
& Pels N. (2009) Medication administration errors in nursing
homes using an automated medication dispensing system.
Journal of the American Medical Informatics Association 16,
486–492.
Van Santen E., Barends D.M. & Frijlink H.W. (2002) Breaking of
scored tablets: a review. European Journal of Pharmaceutics and
Biopharmaceutics 53, 139–145.

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